School District of
Waukesha
Employee Health Insurance Coverage
May 2012
What will be covered in
today’s meeting…
•
Introductions
•
2012 Premiums under the UHC plan
•
UnitedHealthcare benefits for the School District of
Waukesha
•
Information about UHC and how to look up providers
•
Life and Disability Coverage
•
Review of Flexible Spending Accounts
•
Questions
Introductions
Willis is the independent consulting firm assisting the School District and it’s
employees.
Ryan Barbieri - Sr. Vice President
Sharon Schulteis – Sr. Account Manager
UnitedHealthcare is the health insurance company providing coverage to the
District employees
Karen Becker – Account Executive
Andrew Habermann-Field Account Manager
Diversified Benefit Solutions is the administrator of your Flexible Spending Plan.
Paul Dusterhoft – Account Representative
Health Insurance Premium
Employee Contribution Per Month Eff. July 1st, 2012
Coverage
Wellness Participant
Amount per Month (12%)
Non Wellness Participant
Amount Per Month (17%)
Single
$90.51
$128.23
Family
$204.92
$290.31
-Rates are applicable to full time employment. See district for pro-ration if less than full time.
-AFSCME employees have different plan and rates that apply.
-Retirees will have differing premium share per their individual circumstances.
Health Insurance Premium
Retiree Full Monthly Premium Eff. July 1st, 2012
Coverage
Amount per Month
Single
$754.29
Family
$1,707.68
Single Medicare
$441.14 / $154.75*
Family Medicare
$882.27 / $309.49*
Medicare Special
$1,195.42
*Premium for medical only coverage where Medicare D is in place for drug coverage. Applies to post
65 direct bill only.
Health Insurance Benefits
Deductible
Individual
Family
Coinsurance
Lifetime Maximum
Maximum Out-of-Pocket (incls.
Deductible:not co-pays)
Individual
Family
Office Visits
Preventive Care
Hospitalization Services
Emergency Room
Urgent Care
Prescription Drugs
In-Network
Out-of-Network
$675
$1,350
90%
$1,250
$2,500
70%
Unlimited
$1,500
$3,000
$3,750
$7,500
$10 copay then 100%
70% Aft Ded
100%
70% Aft Ded
90% Aft Ded
70% Aft Ded
100% Aft $150 Copay
100% Aft $50 Copay
$10/$20/$35
70% Aft Ded
If you are contemplating
Retirement
When you retire…
 You will qualify for retiree coverage as long as your contract with the
district allows
 At this point your coverage is the same as that of an active employee
When attain age 65…
 You will qualify for a reduced rate if you enroll in Medicare Part A and
Part B
 REMEMBER…Eligibility for Medicare does not equal Enrollment in
Medicare!
 Those retirees that are direct bill and carry Medicare Part D will have a
medical only coverage through the district and a reduced rate
Premium Payments for
District Bill Retirees
• You may use ACH to set up your premium payments to the district
• You may pay on a monthly or quarterly basis
• To set up an ACH, you must complete the following form and return
to the Administration office
Authorization for Direct Payment
I authorize
to initiate entries to my
(Company Name)
Checking Account
Savings Account
This authority will remain in effect until I notify you in writing to cancel it in such time as to afford
the company a reasonable opportunity to act on it. I can stop payment of any entry by notifying
my financial institution 3 days before my account is charged.
Financial Institution
Name (please print)
Transit Routing Number (ABA)
Signature
Account Number
Date
attach a voided check or deposit slip
Find A Network Doctor Or
Hospital
Visit www.myuhc.com
Search by:
• Name or specialty
• Procedure
• Office hours
• Gender
• Education
• Driving directions
• Languages spoken
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Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
UnitedHealthcare
Choice Plus Plan
•Predictable copayments and lower costs for
network care
•Coverage for non-network care, generally payable
at a lower benefit level
•See any network doctor, including specialists,
without referrals
•No need to choose a primary care physician
•100 percent preventive care coverage in our
network
•No need to submit claims for network care
•Care management if you require hospital stay or
surgery
•Prior-authorization may be needed for certain
services
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You have non-network
coverage
You are covered if you
receive care outside of
our network. You save
money when you use
our network.
Preventive Care Services
Include
Examples of covered preventive services include many types of
exams subject to age, gender guidelines, and health status,
which typically include:
Physician office services:
• Routine physical examinations
• Well baby and well child care
• Certain Immunizations
Lab, X-ray or health screening tests:
• Screening mammography
• Screening colonoscopy or sigmoidoscopy
• Cervical cancer screening
• Prostate cancer screening
• Osteoporosis screening
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Take Advantage Of Your
Preventive Care Coverage
Certain preventive services are covered without charging a
deductible, copayment or coinsurance when these services are
provided by a network provider.
It’s important to review your plan documents for the preventive
services included in your specific benefit plan.
Regular preventive care may help
• Reduce risk of disease
• Detect health problems early
• Protect you from higher costs down the road
Take advantage of your preventive care benefits
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Preventive services
Certain services can be done for preventive or diagnostic
reasons.
Covered preventive services performed specifically for
preventive screening, with no known symptoms,
illnesses, or history, are generally covered as Preventive
Care, subject to age and gender guidelines, and health
status.
Preventive services are usually covered when done on a person
who:
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• has not had the preventive screening done before and does not have
symptoms or abnormalities
• has had a screening done within the recommended age/gender guidelines
with the findings considered normal
• has had previous diagnostic services with the results being normal
• has a preventive service done that results in a therapeutic service done at
the same time, and as an integral part of the preventive service (e.g.
polyp removal during a preventive colonoscopy), the therapeutic service
would still be considered preventive service
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Explanation of Benefits (EOBs)
You may notice some changes on
your EOBs beginning late 2011.
You will see more information on:
– Appeal rights
– Consumer assistance
programs
What’s more the EOB has been
designed for easier readability.
We encourage you to access your
EOBs online at myuhc.com.
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Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Quicken Health Expense
Tracker
Simplifies claims information and medical terms
Shows what you owe your provider
Shows account balances
Alerts you to possible physician billing errors
Pay bills quickly
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OptumizeMe™ Program
An engaging
experience for
the consumer–
becoming part
of their lifestyle
© 2011 UnitedHealthcare Services, Inc.
http://www.businesswire.com/portal/site/home/permalink/?ndmViewId=multimedia_detail&eid=6508888&newsLang=en
Facebook, Microsoft, the Windows logo and Business Wire are all registered trademarks of their respective owners.
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Wellness Resources
Health assessment and personalized program information
Latest health news, including healthy recipes
Online quizzes to test your health knowledge
Online health coach to provide information on healthy behaviors
www.myuhc.com
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myNurseLineSM Services
Connect with a registered nurse any time
Get health information from a registered nurse by phone
Prepare yourself before seeking a doctor’s care
Recorded messages on thousands of health topics
Communicate in live, one-to-one Nurse Chats
at myuhc.com
www.myuhc.com
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Care24® Program
Connect with a registered nurse and highly
experienced counselors
Get help with legal, financial and emotional needs
Prepare yourself before you seek a doctor’s care
Access recorded messages on health topics
Communicate in live, one-to-one Nurse Chats
at myuhc.com
www.myuhc.com
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Behavioral Health Support
Access confidential*, specialized help from more than 80,000
licensed and certified professionals nationwide
Receive support for a wide range concerns, including:
»
»
»
»
»
»
»
»
»
Depression, stress and anxiety
Parenting and family problems
Childcare and eldercare stress
Relationship difficulties
Substance abuse and recovery
Dealing with domestic violence
Eating disorders
Balancing work and life issues
And more
We also provide access to inpatient and outpatient
treatment at more than 3,600 locations
* Confidential to the fullest extent permitted by law.
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Personal Health Support
Get support for chronic conditions, complex health care needs
and treatment decisions
Talk by telephone with a registered nurse
Coaching on communicating with doctors/specialists
Learn about diagnosis, treatment options and what to
expect from surgery
We offer disease management programs for:
Cancer Support
Chronic Obstructive Pulmonary Disease (COPD)
Asthma
Coronary Artery Disease (CAD)
Kidney
Diabetes
Heart Failure
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Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Healthy Pregnancy Program
Get support through every stage of pregnancy
Nurses available, toll-free, 24/7
Personalized pregnancy assessment
Educational materials and resources
No Additional Cost Gifts and Savings
–Your Journey Through Pregnancy, a book
that will help you learn more about your
nine-month journey..
–A booklet from Johnson & Johnson:
What’s Next?: The magic unfolding
of the first days of life.
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Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Health Discounts
Save
on products and services not
typically covered by your plan, including:
Laser eye surgery
Cosmetic dentistry
Health club memberships
Weight loss programs and more
Current Members: search under “Health & Wellness”
Disclaimer: Discount programs are not insurance
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Healthy Mind Healthy Body®
e-Newsletter
Award-winning newsletter providing health and medical news
Choose the health topics that interest you
Receive those stories by email each month
Learn about videos, seminars, and
other offerings during the year
Content developed by a Board of Experts
that includes physicians, clinicians
and professional health writers.
Sign up today at
uhc.com/myhealthnews
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Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Source4Women
Health plan information in plain language
Chat with others about health and wellness
Get tips on getting and
staying healthy
Attend online seminars
and events
uhc.com/Source4Women
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Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Life and Short Term
Disability
MetLife will be the Life Insurance carrier effective 7/1
‒ Leading life insurance company serving more than 90 Million
covered individuals
‒ A+ financial rating by A.M. Best
‒ Your coverage and benefits will not change
National Insurance Services / Madison National will be the new
carrier for Employee Paid Voluntary Short Term Disability
‒ Effective 7/1 your coverage will automatically move from WEA
Trust to Madison National
‒ Based out of Madison, WI
‒ A- financial rating by A.M. Best
‒ Benefits will remain the same and employee paid premiums
will be slightly lower in most cases
Long Term Disability
National Insurance Services / Madison National will remain the
insurance carrier for Long Term Disability
Level of benefit will change:
‒ 66.67% income replacement
‒ Disability will be defined as the inability to perform own
occupation for 24 months; after this period the Social Security
Definition of disability will apply
‒ Cost of Living Adjustment (COLA) will follow the Consumer
Price Index (CPI)
‒ The duration of benefit will follow Social Security Normal
Retirement Age
‒ All other benefit provisions will remain unchanged
Diversified Benefit Services, Inc.
School District of Waukesha
Flexible Spending Account (FSA)
What can a FSA do for you?

Allows employees to pay for certain
expenses tax-free

Take
Home
Pay
Increase your take home pay by lowering
your taxes

Average person saves around 20-30% in
taxes on their qualified expenses
What can a FSA do for you?
Federal Income Tax
15.00%
Wisconsin Income Tax
6.50%
Social Security Tax
6.20%
Medicare Tax
1.45%
TOTAL SAVINGS
29.15%
$
Benefit Categories

Medical Reimbursement Account

Dependent Care Reimbursement Account
Medical Reimbursement Account

Provides tax-free reimbursement for out-ofpocket medical, dental, & vision expenses as
well as prescription drugs, and more

Utilize whether on health plan or not

Includes expenses for your spouse and/or legal
dependents.
Medical Reimbursement Account
Eligible Out-of-Pocket Expenses Include:
 Medical Insurance deductibles, co-pays and co-insurance
 Dental Insurance deductibles and co-insurance
 Dental expenses such as exams, caps, crowns, bridges & filings
 Orthodontia
 Vision exams, glasses, frames, contact lenses & supplies
 Lasik eye surgery
 Hearing aids (including batteries)
 Routine exams/physicals/mammograms
 Chiropractor costs
 Prescription drugs
 Other expenses not reimbursed by insurance
 Mileage to obtain medical care (23.5¢/mile)
Medical Reimbursement Account
Expenses which are NOT ELIGIBLE include:
 Surgery for cosmetic reasons
 Medical supplies that are not medically necessary
 Teeth bleaching/whitening/bonding
 Health club membership dues
 Over the counter vitamins and other dietary supplements for general
health purposes
 Cosmetic drugs
 Marriage counseling
 Group insurance premiums deducted from your paycheck
Medical Reimbursement Account

Estimate your expenses you expect to incur
during the Plan Year (7/1/12 – 06/30/13)

Maximum amount: $2,500

Amount divided in equal installments pre-tax
Incur expenses

Dates of service July 2012 – June 2013
Medical Reimbursement Account


Access to annual election at anytime

School District of Waukesha fronts the money

You pay back over the entire year
Flexible


Use for any expenses within the account
Tax-free dollars

No Federal, State or FICA taxes paid
Medical Reimbursement Account
How to Receive Reimbursements

Submit claim form and documentation
verifying expenses (copies)




Nature of the expense
Date of service
Out-of-pocket cost
Name of the provider

Mail/fax claim to DBS

Email notifications will be sent to inform you of claims received,
reimbursements issued or requests for additional information
needed to process your claims.
Claim Form
John J. Doe
jjdoe@hotmail.com
School District of Waukesha
7 20 12
John J Doe
$200
07/12/12
Diversified Benefit Services, Inc.
07/18/12
Dependent Care Reimbursement
Account

Provides tax-free reimbursement for the cost of
child care or the daycare of an adult who lives
with you and whom you claim as a dependent

Can be a day care center or private individual

You must report the provider’s Federal Tax ID
number or Social Security number
Dependent Care Reimbursement
Account

To qualify, the daycare expenses must be while
you (and your spouse, if you are married) are
working, seeking employment or attending
college on a full-time basis

You must report your daycare contributions on
Federal Tax Form 2441
Dependent Care Reimbursement
Account

Estimate your expenses you expect to incur
during the Plan Year (7/1/12 – 06/30/12)

Maximum amount: $5,000


Family cap
Amount divided in equal installments pre-tax
Incur expenses

Dates of service July 2012 – June 2013
Dependent Care Reimbursement
Account

Submit claim form with provider signature OR

Submit claim form and documentation
verifying expenses (copies)




Nature of the expense
Date of service
Out-of-pocket cost
Name of the provider

Mail/fax claim to DBS

Email notifications will be sent to inform you of claims received,
reimbursements issued or requests for additional information
needed to process your claims.
Claim Form
Dependent Care Section
225.00
Little Angels Child Care
123-45-6789
21-56368
08/01/2012 08/12/2012
Caroline Crumbcruncher
Dependent Care Reimbursement
Account

May access up to the amount contributed from
paycheck

Alternative tax break: Tax Credit (form 2441)

Consult your tax advisor

Cannot use the same expenses under both plans
Important plan rule!

IRS rules require that you use the money
you set aside during the plan year

Unused money is forfeited

Most people do not leave money in the
plan
Most money utilized

Most people do not leave money in the plan

Why?

Plan for routine expenses


Example: Prescription copays
Miscellaneous expenses

Saline solutions

Mileage for medical visits
Other information

The Dependent Care Reimbursement Account and
the Medical Reimbursement Account are separate
accounts

Current Participants: File 2011-12 expenses by
09/30/2012
Enrollment Information
Enroll Online!
Refer to the information you
have received for detailed
instructions.
Enroll no later than 06/08/2012
Conclusion
FSAs can:

Increase your spendable income

Lower your taxes

Benefit you and your family
Contact Information
Diversified Benefit Services Customer
Representatives are available during normal business
hours to answer any questions you may have.
800-234-1229
Online account viewing available at
www.dbsbenefits.com
What’s Next?
•No re-registration is needed to enroll you in the new plan. This
will be handled automatically.
•Do see the Business Office if you have any enrollment changes
•New ID cards will be sent to your home closer to 7/1/2012, at
that time discard old ID card
Questions…